Provider Demographics
NPI:1396999397
Name:PERKINS, FAITH E (DEVELOPMENTAL THERAP)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:E
Last Name:PERKINS
Suffix:
Gender:F
Credentials:DEVELOPMENTAL THERAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1919
Mailing Address - Country:US
Mailing Address - Phone:207-667-6783
Mailing Address - Fax:207-667-0668
Practice Address - Street 1:102 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1919
Practice Address - Country:US
Practice Address - Phone:207-667-6783
Practice Address - Fax:207-667-0668
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3699251041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME135310200OtherMAINECARE